Michael James Foundation Scholarship Application

Michael James Foundation, a 501(c)(3) Charitable Organization

Name *

Email *

Phone number *

Address or Rehab facility where you are currently residing *

How should we contact you *

Phone

Mail

Are you applying for yourself or someone else *

Name of facility you are requesting scholarship assistance for

Name and contact information of who referred you to Michael James Foundation

Please provide an additional reference and contact information related to your sobriety

Please provide a brief description of your sobriety experience to-date and your long term goals

What are your immediate needs (application fees, rent, transportation) Please be specific *

How much in Scholarship assistance are you applying for *